A randomized controlled trial of the impact of pharmacist-led patient-centered pharmaceutical care on patients' medicine therapy-related quality of life

Impact of pharmacist-led pharmaceutical care on health-related and pharmaceutical therapy-related quality of life in patients with heart failure: A randomized controlled trial

BACKGROUND

Data on the impact of pharmacist-led pharmaceutical care (PC) on pharmaceutical therapy-related and health-related quality of life (HRQoL) and their sensitivities to PC provision in patients with heart failure (HF) are scarce.

OBJECTIVES

This study aimed to assess the impact of pharmacist-led PC on HRQoL employing the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and 5-level EuroQol 5 dimension (EQ-5D-5L) and on pharmaceutical therapy-related quality of life using the Patient-Reported Outcomes Measure of Pharmaceutical Therapy (PROMPT) in HF patients and compare sensitivities to the PC provision of these three tools.

METHODS

A single-blinded randomized controlled trial was conducted at a tertiary public hospital in Thailand between November 2022 and May 2023. Overall, 250 patients were randomly divided into the usual care (UC) (N = 124) and PC (N = 126) groups. Mixed effects models were used to investigate the differences in the mean change scores of PROMPT, EQ-5D-5L, and MLHFQ between the UC and PC groups. The sensitivities to PC provision of the three measures were evaluated using standardized effect sizes (SESs).

RESULTS

Significant differences were found in five of eight domains and the total score of the PROMPT between the PC and UC groups (all p < 0.05). However, no significant differences were found in the EQ-5D-5L and MLHFQ between the two groups (both p > 0.05). The SESs of the five domains and total score of PROMPT ranged from 0.29 to 1.65, considered small-to-large effect sizes, whereas the SESs of EQ-5D-5L and MLHFQ were -0.4 to 0, considered small effect sizes.

CONCLUSIONS

Pharmacist-led PC can positively affect pharmaceutical therapy-related quality of life using PROMPT in HF patients. Additionally, PROMPT is more sensitive to PC provision than EQ-5D-5L and MLHFQ.

Components of pharmacist-led medication reviews and their relationship to outcomes: a systematic review and narrative synthesis

INTRODUCTION

Pharmacist-led medication reviews are an established intervention to support patients prescribed multiple medicines or with complex medication regimes. For this systematic review, a medication review was defined as 'a consultation between a pharmacist and a patient to review the patient's total medicines use with a view to improve patient health outcomes and minimise medicines-related problems'. It is not known how varying approaches to medication reviews lead to different outcomes.

AIM

To explore the common themes associated with positive outcomes from pharmacist-led medication reviews.

METHOD

Randomised controlled trials of pharmacist-led medication reviews in adults aged 18 years and over were included. The search terms used in MEDLINE, EMBASE and Web of Science databases were "medication review", "pharmacist", "randomised controlled trial" and their synonyms, time filter 2015 to September 2023. Studies published before 2015 were identified from a previous systematic review. Risk of bias was assessed using the Cochrane risk of bias 2 tool. Descriptions of medication reviews' components, implementation and outcomes were narratively synthesised to draw out common themes. Results are presented in tables.

RESULTS

Sixty-eight papers describing 50 studies met the inclusion criteria. Common themes that emerged from synthesis include collaborative working which may help reduce medicines-related problems and the number of medicines prescribed; patient involvement in goal setting and action planning which may improve patients' ability to take medicines as prescribed and help them achieve their treatment goals; additional support and follow-up, which may lead to improved blood pressure, diabetes control, quality of life and a reduction of medicines-related problems.

CONCLUSION

This systematic review identified common themes and components, for example, goal setting, action planning, additional support and follow-up, that may influence outcomes of pharmacist-led medication reviews. Researchers, health professionals and commissioners could use these for a comprehensive evaluation of medication review implementation.

PROSPERO REGISTRATION NUMBER

CRD42020173907.

Designing Hospital and Pharmacy Services for Visually Impaired Persons in Bangkok, Thailand

This cross-sectional study aimed to develop a hospital and pharmacy services model from the patient's perspective, identifying the gap and domain for services improvement. The study was conducted on 140 persons aged ≥ 18 years with visual impairment or low vision in Bangkok, Thailand. The results demonstrated that patients' perceived services were not inclusively designed for visually impaired persons. The domains with the highest gap analysis score were navigation systems, followed by a detailed explanation, such as dose mismanagement, observed medication expiration dates, and pharmacy self-identification. The patient-centered service model empowered visually impaired persons to achieve medication outcomes and safety.

Comparison of the sensitivities of pharmacotherapy-related and disease-specific quality of life measures in response to pharmacist-led pharmaceutical care for cancer outpatients: a randomised controlled trial

BACKGROUND

No data were previously available regarding the sensitivities of pharmacotherapy-related and disease-specific quality of life measures to pharmacist-led pharmaceutical care (PC).

AIM

The aim was to compare the sensitivities of two health-related quality of life (HRQoL) measures, i.e. the Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) versus the Functional Assessment of Cancer Therapy-General (FACT-G), in response to pharmacist-led PC for cancer outpatients.

METHOD

A randomised controlled trial was conducted on cancer outpatients of a tertiary Thai hospital. Eligible patients were randomly allocated to a PC group receiving PC interventions or a usual care (UC) group receiving pharmacist's standard care. The HRQoL of both groups was assessed using the PROMPT-QoL and the FACT-G before and after intervention. The sensitivities of the two measures were determined using standardised mean differences (SMDs).

RESULTS

A total of 237 patients in two arms (120 PC vs. 117 UC patients) completed the trial. With PC interventions, all eight PROMPT-QoL domains and 3 out of 4 FACT-G domains were significantly improved. The PROMPT-QoL yielded SMDs ranging from 0.24 to 1.68 that were considered moderate-to-high sensitivity, while the FACT-G provided moderate sensitivity with SMDs of 0.31-0.64. The average SMDs of four FACT-G domains was 0.50 and SMD of the total score was 0.80. Eight PROMPT-QoL domains had the average SMD of 0.60 and the total score SMD was 1.40.

CONCLUSION

The PROMPT-QoL is more sensitive to detect HRQoL when delivering pharmacist-led pharmaceutical care to cancer outpatients.

TRIAL REGISTRATION

TCTR20210809008.

Effect of Pharmaceutical Intervention in Pharmacologically Treated Hypertensive Patients-A Cluster-Randomized Clinical Trial: AFPRES-CLM Study

BACKGROUND

Evaluate the effect of a community pharmaceutical intervention on the control of blood pressure in hypertensive patients treated pharmacologically.

METHODS

A cluster-randomized clinical trial of 6 months was carried out. It was conducted in the Autonomous Community of Castilla-La Mancha (Spain). Sixty-three community pharmacies and 347 patients completed the study. Intervention patients received the community pharmaceutical intervention based on a protocol that addresses the individual needs of each patient related to the control of their blood pressure, which included Health Education, Pharmacotherapy Follow-up and 24 h Ambulatory Blood Pressure Measurement. Control patients received usual care in the community pharmacy.

RESULTS

The pharmaceutical intervention resulted in better control of blood pressure (85.8% vs. 66.3% p < 0.001), lower use of emergencies (p = 0.002) and improvement trends in the physical components of quality of life, measured by SF-36 questionnaire, after 6 months of pharmaceutical intervention. No significant changes were observed for any of these variables in the control group. There were also detected 354 negative medication-related outcomes that were satisfactorily resolved in a 74.9% of the cases and 330 healthcare education interventions and 29 Ambulatory Blood Pressure Monitorings were performed in order to increase adherence to pharmacological treatment and minimize Negative Outcomes associated with Medication and prevent medication-related problems.

CONCLUSIONS

Community pharmaceutical intervention can increase hypertensive patients with controlled blood pressure, after 6 months, compared with usual care.

Effect of medication therapy management services on medication-burden quality of life in hemodialysis patients

BACKGROUND

Hemodialysis (HD) patients commonly receive polypharmacy leading to increased likelihood of drug related problems (DRPs) and poor quality of life. Medication Therapy Management (MTM) services discover and resolve DRPs and may specifically improve Medication-burden Quality of life (MBQoL) in HD patients. We aimed to assess the effect of MTM services on DRPs and MBQoL among HD patients.

METHODS

A prospective pre-post study was conducted on 104 patients in an HD unit in Alexandria, Egypt. MBQoL was assessed at baseline and after three months of MTM sessions, using the Arabic, validated version of the Patient Reported Outcomes Measure of Pharmaceutical Therapy (PROMPT) questionnaire. Cohen's d test and multiple linear regression were used to assess the effect size of MTM and the factors affecting MBQoL, respectively. DRPs, adverse events and adherence were also monitored.

RESULTS

MBQoL improved significantly after the implementation of MTM (Cohen's d=0.88, p < 0.01) with the largest effect size in the "medicine information and relation with healthcare providers" domain. DRPs decreased significantly after MTM implementation (11.97 ± 4.65 versus 7.63 ± 3.85 per patient, p<0.001). The mean adverse events per patient were also reduced (9.69 ± 4.12 versus 6.56 ± 3.77, p < 0.001).

CONCLUSION

Applying MTM services presents an opportunity to improve care for HD patients by improving MBQoL, decreasing DRPs and adverse events.

Association of pharmacist intervention counseling with medication adherence and quality of life: A systematic review and meta-analysis of randomized trials

OBJECTIVE(S)

To assess the association between pharmacist intervention counseling with medication adherence and quality of life. Also, to assess if these associations vary by the focus, structure, training, or robustness of the counseling.

METHODS

The initial search identified 1805 references, of which 62 randomized trials (RCTs) met inclusion criteria for the systematic review. Of the 62 RCTs, 60 (with 62 results) had extractable data for the meta-analysis. Data were pooled using a random-effects model.

RESULTS

Most study patients were older and taking multiple prescription drugs. The pooled results showed a statistically significant increase in the odds of medication adherence with the pharmacist counseling intervention versus no counseling (pooled odds ratio [OR] = 4.41; 95% confidence interval [CI] 2.46-7.91; P < 0.01). The results of a subgroup analysis suggest the primary disease, counseling focus, location, and robustness may modify the effect of pharmacist counseling on medication adherence. There was a statistically significant improvement in the quality of life with pharmacist counseling versus no pharmacist counseling (pooled standardized mean difference [SMD] = 0.69; 95% CI 0.41-0.96; P < 0.01). The results of a subgroup analysis suggest that counseling focus, location, training, robustness, and the measurement method, but not the disease category, may modify the effect of pharmacist counseling on quality of life.

CONCLUSION

The evidence supports pharmacist intervention counseling to increase mediation adherence and quality of life. The counseling location and structure may be significant factors in improving medication adherence. The overall methodological quality of evidence was very low.

Outcomes of Pharmacist-Led Pharmaceutical Care Interventions Within Community Pharmacies: Narrative Review

Pharmaceutical care (PhC) services interventions led by pharmacists within community pharmacies (CPs) are essential in achieving optimal medication use outcomes. PhC is a concept related to medication use goals optimization through the reduction and prevention of drug-related problems (DRPs). This review paper summarized the literature on pharmacist-led PhC interventions within CPs. PubMed and Google Scholar publications were searched, identified, and summarized. Results showed that some studies handled community pharmacists' roles, and some talked about PhC interventions. However, some studies reviewed the use of medicines, adherence, and follow-up, while other groups were on counseling, patient education, and health promotion. Pharmacists integrated some studies concerning diagnosis and disease screening into community pharmacy services. Besides these studies, there were studies on system design and installation of PhC service models. Most of the identified research results showed pharmacist-led intervention benefits for patients. These benefits include reduced DRPs, clinical, economical, humane, education and knowledge, disease prevention and immunization, identification of practice process problems, and the need for current practice redesigning. In conclusion, pharmacists can help patients achieve optimal outcomes through pharmacist-led interventions. Despite mentioned results, We recommend researching comprehensively applied PhC services provision models within CPs for more pharmacists-led interventions and role activation.

Medication review in hospitalised patients to reduce morbidity and mortality

BACKGROUND

A medication review can be defined as a structured evaluation of a patient's medication conducted by healthcare professionals with the aim of optimising medication use and improving health outcomes. Optimising medication therapy though medication reviews may benefit hospitalised patients.

OBJECTIVES

We examined the effects of medication review interventions in hospitalised adult patients compared to standard care or to other types of medication reviews on all-cause mortality, hospital readmissions, emergency department contacts and health-related quality of life.

SEARCH METHODS

In this Cochrane Review update, we searched for new published and unpublished trials using the following electronic databases from 1 January 2014 to 17 January 2022 without language restrictions: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). To identify additional trials, we searched the reference lists of included trials and other publications by lead trial authors, and contacted experts.

SELECTION CRITERIA

We included randomised trials of medication reviews delivered by healthcare professionals for hospitalised adult patients. We excluded trials including outpatients and paediatric patients.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials, extracted data and assessed risk of bias. We contacted trial authors for data clarification and relevant unpublished data. We calculated risk ratios (RRs) for dichotomous data and mean differences (MDs) or standardised mean differences (SMDs) for continuous data (with 95% confidence intervals (CIs)). We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess the overall certainty of the evidence.

MAIN RESULTS

In this updated review, we included a total of 25 trials (15,076 participants), of which 15 were new trials (11,501 participants). Follow-up ranged from 1 to 20 months. We found that medication reviews in hospitalised adults may have little to no effect on mortality (RR 0.96, 95% CI 0.87 to 1.05; 18 trials, 10,108 participants; low-certainty evidence); likely reduce hospital readmissions (RR 0.93, 95% CI 0.89 to 0.98; 17 trials, 9561 participants; moderate-certainty evidence); may reduce emergency department contacts (RR 0.84, 95% CI 0.68 to 1.03; 8 trials, 3527 participants; low-certainty evidence) and have very uncertain effects on health-related quality of life (SMD 0.10, 95% CI -0.10 to 0.30; 4 trials, 392 participants; very low-certainty evidence).

AUTHORS' CONCLUSIONS

Medication reviews in hospitalised adult patients likely reduce hospital readmissions and may reduce emergency department contacts. The evidence suggests that mediation reviews may have little to no effect on mortality, while the effect on health-related quality of life is very uncertain. Almost all trials included elderly polypharmacy patients, which limits the generalisability of the results beyond this population.

A nationwide exploratory survey assessing perception, practice, and barriers toward pharmaceutical care provision among hospital pharmacists in Nepal

Pharmaceutical care (PC) services reduce medication errors, improve the use of medicines, and optimize the cost of treatment. It can detect medication-related problems and improve patient medication adherence. However, PC services are not commonly provided in hospital pharmacies in Nepal. Therefore, the present study was done to determine the situation of PC in hospital pharmacies and explore the perception, practice, and barriers (and their determinants) encountered by hospital pharmacists while providing PC. A descriptive online cross-sectional study was conducted from 25th March to 25th October 2021 among pharmacists with a bachelor’s degree and above working in hospital pharmacies using non-probability quota sampling. The questionnaire in English addressed perception and practice regarding PC, and barriers encountered and were validated by experts and pre-tested among 23 pharmacists. Descriptive statistics were used to describe the data. Kendall’s correlation was used to explore the correlations among various perception and practice constructs. The scores were also compared among subgroups of respondents using the Mann–Whitney test for subgroups with two categories and Kruskal–Wallis test for greater than two categories. A total of 144 pharmacists participated in the study. Majority of the participants were male, between 22 and 31 years of age, and had work experience between 10 and 20 years. Over 50% had received no training in PC. The perception scores were higher among those with more work experience and the practice scores among those who had received PC training. Participants agreed that there were significant barriers to providing PC, including lack of support from other professionals, lack of demand from patients, absence of guidelines, inadequate training, lack of skills in communication, lack of compensation, problems with access to the patient medical record, lack of remuneration, and problems with accessing objective medicine information sources. A correlation was noted between certain perceptions and practice-related constructs. Hospital pharmacists who participated had a positive perception and practice providing PC. However, PC was not commonly practised in hospital pharmacies. Significant barriers were identified in providing PC. Further studies, especially in the eastern and western provinces, are required. Similar studies may be considered in community pharmacies.

Concordance of pharmacist versus patient responses regarding counselling in community pharmacy

RATIONALE AND OBJECTIVES

Patient counselling on medication is one of the activities that can and should be performed in community pharmacy. Patient counselling was proved to have a positive effect on clinical outcomes, quality of life, drug/disease knowledge, satisfaction and reduced health-service utilization. Our objective was to assess the degree of concordance between the responses of patient and pharmacist on the same questions regarding provided counselling.

METHODS

Data from two questionnaires containing a common block of 14 questions regarding the counselling provided on the medications use, safety concerns, storage, validity term, disposal and disease monitoring was paired and analysed. Questionnaires were paired based on a code and Kappa Cohen coefficient (KCc) and the prevalence adjusted biased adjusted kappa (PABAK) were calculated to evaluate the degree of concordance between pharmacist versus patient responses. The values of the KCc and PABAK were interpreted as per Altman.

RESULTS

For the 14 questions, data from 2047 to 2378 questionnaires collected from 520 community pharmacies in 10 of Romania's counties were analysed. The highest level of concordance ('very good') was achieved on the items regarding the counselling on the medicines' route of administration (PABAK = 0.88), time of administration (PABAK = 0.80) and dosage (PABAK = 0.82). The highest disagreement (week concordance) was found on the question regarding the counselling on the medicines adverse effects (PABAK = 0.01), where 44.8% of patients responded that they received counselling as compared to 93.1% of the pharmacists who responded that they offered counselling. For the rest of the questions, moderate concordance was found.

CONCLUSION

Overall a moderate level of concordance between patient and pharmacist responses was found on the majority of the questions, with the highest level found for drug use (dosage, route and time of administration). The highest discrepancy was found for the counselling on the medicines adverse effects.

Impact of a drug-related patient-reported outcome measure on drug-related problem identification, physicians' acceptance, and clinical and quality of life outcomes: a randomized controlled trial

BACKGROUND

Data are scarce regarding the usefulness of a pharmaceutical therapy-related quality of life measure including the Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL), for providing pharmaceutical care.

AIM

To evaluate the impact of the PROMPT-QoL on identifying drug-related problems (DRPs), physicians' acceptance of pharmacist's recommendations on the DRP resolution, and clinical and quality of life outcomes.

METHOD

A single-blind randomized controlled trial was conducted at a tertiary public hospital in Thailand from October 2019 to May 2020. A total of 286 outpatients with chronic diseases were randomly allocated into the control group (provided with pharmaceutical care only) (N = 146) and the intervention group (provided with pharmaceutical care together with use of the PROMPT-QoL) (N = 140).

RESULTS

A significantly higher mean number of DRPs could be identified in the intervention group than in the control group (p < 0.001). Moreover, there was a significantly higher proportion of physicians' acceptance of pharmacist's recommendations on the DRP resolution in the intervention than in the control group (p = 0.019). Regarding the clinical outcome, a significantly higher proportion of the DRP resolution was found in the intervention group than in the control group (p = 0.002). For quality of life outcomes, the intervention group yielded a significantly higher mean difference between posttest and pretest on the Medicine and Disease Information domain score of the PROMPT-QoL (p = 0.029) and the EuroQoL-Visual Analog Scale score (p = 0.031) than the control group.

CONCLUSION

This study revealed that the application of the PROMPT-QoL together with pharmaceutical care favorably influenced identification of DRPs, physicians' acceptances, and clinical outcomes. Trial registration TCTR20201208005 on December 5, 2020.

Medication-Related Needs and Humanistic Impact of Patient-Centered Pharmaceutical Care at University of Gondar Comprehensive Specialized Hospital, North-West Ethiopia

Purpose

To assess patients’ medication-related needs and the humanistic impact of patient-centered pharmaceutical care.

Patients and Methods

A hospital-based cross-sectional study was conducted using self-administered structured questionnaires from February 4 to 28, 2019, on patients attending ambulatory care for chronic non-communicable diseases at the University of Gondar specialized teaching hospital, North-west Ethiopia. Data were entered to SPSS version 22 for analysis. Descriptive statistics was used to describe the socio-demographic characteristics and medication-related needs of study participants. Independent sample t-test and one-way ANOVA analysis were performed to check for possible associations between dependent and independent variables.

Results

Information about what to do if patients missed doses and the potential side-effects or abnormal conditions caused by the prescribed medicines were not explained for most of the 425 patients studied. The majority of the study participants reported that they felt worried about adverse medicine effects, drug interactions, and long-term medicine use. Patients who were older than 50 or those receiving two or more medications were less satisfied with the effect of their medicine as compared to younger ones and those on monotherapy, respectively. People who were illiterate or had attended only primary schools thought that they received less disease and medicine information from health professionals than people who attended tertiary education.

Conclusion and Recommendation

Most of the participants were particularly unhappy with the amount of information received about side-effects and what to do if doses were missed. Special emphasis should be given to patients with a low level of education as they were not satisfied with medicine and disease information obtained from health professionals, experienced more psychological impacts of medicine use, and had poor overall quality-of-life.

Medication-Related Quality of Life in Thai Epilepsy Patients

Background and Purpose

This study aimed to assess medication-related quality of life in Thai patients with epilepsy. The second objective was to evaluate the associations between the medication therapy-related quality of life and patient characteristics.

Methods

This was a cross-sectional study. A convenience sample of 173 outpatients with epilepsy was recruited from a university hospital in Bangkok, Thailand. Inclusion criteria were aged 18 or over who were continuously taking an epileptic drug for at least 3 months, understanding Thai language, and willing to participate in the study. The Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) was utilized to measure the medication therapy-related quality of life. Pearson’s correlation coefficients and stepwise multiple linear regressions were employed to assess the relationships between eight PROMPT-QoL domain scores and patient demographic and clinical characteristics.

Results

Mean age was 36.4±9.5 years and approximately 57% were female. Among eight domains of the PROMPT-QoL, the therapeutic relationships with health care providers and psychological impacts of medication use domains yielded the highest (77.9) and lowest (61.9) mean scores, respectively. Seven out of eight PROMPT-QoL domain scores were considered as moderate-to-good. Age, gender, duration of epilepsy, seizure frequency, and treatment preference were significantly associated with PROMPT-QoL domain scores in multivariate linear regression analyses.

Conclusions

This study showed that Thai patients with epilepsy had moderate-to-good medication therapy-related quality of life. Healthcare providers should pay more attention to patients’ psychological impacts of antiepileptic drugs and those with characteristics related to lower medication therapy-related quality of life.

Relationships Between Pharmaceutical Therapy-Related Quality of Life and Health Utility Scores in Thai Patients With Chronic Diseases

OBJECTIVES

The purpose of this study was to assess the relationships between pharmaceutical therapy-related quality of life (PTRQoL) and health utility (HU) scores since such data was not available.

METHODS

The dataset of 1156 outpatients with chronic diseases from 3 public university hospitals in Bangkok, Thailand, were applied. The Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) was utilized to assess PTRQoL. HU measures included EQ-5D-5L and EuroQoL-Visual Analog Scale (EQ-VAS). Multiple linear regressions using a stepwise approach were applied to evaluate the relationships between the PROMPT-QoL and the HU scores.

RESULTS

The results found that the EQ-5D-5L was mostly correlated with the impacts of medicines and side-effects followed by the medicine effectiveness, psychologic impacts of medication use, and availability and accessibility domains of the PROMPT-QoL, respectively (actual R² about 18%). The EQ-VAS was mostly associated with the impacts of medicines and side-effects, followed by the medicine effectiveness and overall quality of life domains, respectively (actual R² about 14%).

CONCLUSIONS

The PROMPT-QoL had medium correlations with the EQ-5D-5L and EQ-VAS scores. Their relationships depended on HU approaches used. More research is needed to examine the relationships between the PROMPT-QoL or other PTRQoL instruments and other HU scores in other settings and populations.

Pharmacotherapy related quality of life in Thai patients with chronic diseases

Background Little was known about patient's pharmacotherapy related quality of life (PTRQoL) and its differences between disease groups. Objective First, to assess PTRQoL in Thai patients with chronic diseases using the Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL). Second, to determine the differences in PROMPT-QoL domain scores and total scores between disease groups. Setting Three public university hospitals in Bangkok, Thailand. Method Eleven hundred and fifty-six adult outpatients continuously taking medicines to treat their diseases for at least 3 months were conveniently sampled. Bonferroni post hoc tests were used to determine the differences in eight PROMPT-QoL domain scores and total scores between 14 disease groups. Main outcome measure The descriptive statistics of PROMPT-QoL domains and the total score. Results Approximately two-thirds of all patients preferred to use only medicines for treating their diseases. Impacts of Medicines and Side-Effects and Medicine and Disease Information yielded the highest (87.3) and lowest (55.4) mean domain scores, respectively. The other domains and the total score provided the average scores between 65 and 75, which were interpreted as moderate-to-good. Bonferroni post hoc tests showed that there were five domains providing significantly different scores between disease groups. They included Medicine and Disease Information, Satisfaction with Medicine Effectiveness, Impacts of Medicines and Side-effects, Convenience, and Therapeutic Relationships with Healthcare Providers domains. Conclusion Pharmacotherapy related quality of life in Thai patients is moderate-to-good. Five of eight pharmacotherapy related quality of life domain scores differed by disease groups.

Development and psychometrics of a short-form pharmaceutical care-specific measure for quality of life

Background The validated patient-reported outcomes measure of pharmaceutical therapy for quality of life (PROMPT-QoL) contains 43-items, and can be too lengthy for some applications. Objectives To develop a brief version called the PROMPT, and test its psychometric properties. Setting Four public hospitals in Bangkok, Thailand. Method Secondary analysis of three databases used to develop and evaluate the original PROMPT-QoL. Items for the short-form PROMPT were selected based on expert and patient evaluations of content and importance, and lack of redundancy. All domains of the original version are represented in the PROMPT. Main outcome measures Psychometric properties (internal consistency and test-retest reliability, criterion, convergent and discriminant validity, and responsiveness), and indicators of practicality (e.g., administration time, missing data). Results Analyses of the PROMPT and its domain subscales demonstrated good internal consistency and fair-to-excellent test-retest reliability. Correlations between the original and short-form, overall and by domain, were high. Expectations for convergent and discriminant validity were met as correlations between the PROMPT and generic health-related quality of life measures (WHOQoL-BREF domains and summary scores of the SF-12v2) were modest (< 0.40). Based on data from a trial of pharmaceutical care, the PROMPT short-form was very responsive to reductions in medication related problems. Administration time for the PROMPT is estimated to be about 5 min, and across all datasets used, no missing data were found amongst the 16 items of the PROMPT. Conclusion The 16-item PROMPT appears to be a practical, reliable, valid, and responsive instrument to identify patient's drug-related needs and to assess the humanistic impact of patient-centered pharmaceutical care.